Provider Demographics
NPI:1083760573
Name:RAVI MEDICAL GROUP SC
Entity Type:Organization
Organization Name:RAVI MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-889-2000
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-889-2000
Mailing Address - Fax:630-889-2299
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-889-2000
Practice Address - Fax:630-889-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
210666Medicare ID - Type UnspecifiedGROUP ID